Parenteral Medications Part 1

Equipment

What is meant by the term “Sterile”?

Identify the parts of a needle and syringe that must remain

STERILEwhen preparing an injection.

Needle Gage

Parts of a Needle

Sterile Parts of the Syringe

List three examples of how contamination can occur while

preparing an injection.

How can contamination be avoided?

How are the following syringes calibrated?

3 cc or 3 ml Syringe

Tuberculin or TB Syringe

Insulin Syringe

Needles are sized by gage and length

Which is larger?

18 gauge needle

28 gauge needle

Common lengths

3/8 to 1 1/2 inches

Bevel- The slanted opening. Always go “bevel up”Shaft-The steel part

Hub-The plastic, colored part

The best size is the smallest needle that will do the job!

This means that the needle must be large enough to place the medication

in the correct place without unnecessary trauma to the site.

NEVER, NEVER, NEVER recap a dirty needle!Dispose of it immediately in the sharps container

You MAY recap clean needles (needles that have not entered skin)Recapping

If you must recap, use the one-handed SCOOP methodLay the cap down and scoop the needle into the cap

Click the lid closed using the other hand but not pushing from the topThis Is Important

You need to have a healthy respect for needles. It’s easy to stick yourself.

Describe the protocol to be followed if you stick yourself with a contaminated needle.

&

Working with an Ampule

Drawing up a medication from an ampule:

•Move fluid to the bottom•Safely open the ampule with alcohol wipe•Break away from you•Use a filter needle if possible•Change needles and inject•Demo•http://irtreal.austincc.edu/ramgen/departments/ahs/emsp/mDrwAmp.smil

Use alcohol instead of 4x4

Working with a Vial

Once opened, how long can a multi-dose vial be used assuming

that it has not been contaminated?

Differentiate between the 2 expiration dates found on an

opened multi-dose vial.

Labeling a Newly Opened Vial

Date & Time Opened and Your Initials:

2/5/09 @ 0930 CM

Date & Time Vial Expires - 30 Days:

3/5/09 @ 0930

How can a multi-dose vial be protected from contamination?

How much air is injected into a multi-dose vial prior to withdrawing the desired volume of liquid?• http://irtreal.austincc.edu/ramgen/departmen

ts/ahs/emsp/mDrwVial.smil Immediately put new needle on or cap with sterile cap

Intramuscular

• Syringe?– Up to 4 ml except in deltoid. No more than 1ml in deltoid

• Needle?– 21-23g, 1-1.5” long

• Angle?– 90 degrees

• Always aspirate for blood return– You will be very close to blood vessels and nerves– If you see blood return, withdraw the needle immediately

Let’s give it a try!•Draw up 1 ml. of saline• consider .2ml for airlock•Prep a site•Give an injection•Demo•http://irtreal.austincc.edu/ramgen/departments/ahs/emsp/mIM.smil

–2x2 gauze

Subcutaneous

• Syringe?– TB or insulin syringe

• Needle?– 25-29 g 3/8-5/8”

• Angle?– Short needle-- 90 degrees– Long needle-- 45 degrees– Don’t aspirate with insulin and heparin

• Do not massage site• Pinch up skin or hold taut

• Demo

Evidence based practice

• Research is the basis for nursing practice,• The buzz word for this research or analysis is

Evidenced based practice.• An example is this article on how fast to inject

heparin sq• http://www.blackwell-synergy.com/doi/abs/10.104

6/j.1365-2648.2001.01925.x?cookieSet=1&journalCode=jan

Intradermal

• Syringe?– Tuberculin—Up to 1 ml

• Needle?– 25-27g, ¼-1/2 “ long

• Angle?– 10-15 degrees– Bevel up

• Make a wheal or bleb• Demo

Dissolving a powdered Drug:

•Common diluents

•Volume selection

•Mixing techniques

•Which do you use?

Let’s reconstitute the Practi-Powder, prepare a dose, and actually give an

injection!

Practi Powder

Preparing a Dose Using a Powdered Medication

• Reconstitute with 6 ml of Bacteriostatic N/S• Each ml. of reconstituted Practi-medication

contains 500 mg of medication• Order states administer 750 mg IM• How much medication will you administer?• Demo

Practi-

Powder